A 68-Year-Old Man Comes to the Emergency Department Due to 12

question 1061

Multiple Choice

A 68-year-old man comes to the emergency department due to 12 hours of worsening abdominal pain, nausea, and vomiting.  The patient has had intermittent abdominal discomfort and nausea over the past several months but not to this severity.  He has had no diarrhea, and his most recent bowel movement was 1 day ago.  The patient has no known medical conditions and takes no medications.  He has smoked a pack of cigarettes daily for 30 years and drinks 1 or 2 alcoholic beverages daily.  Temperature is 38.5 C (101.3 F) , blood pressure is 106/64 mm Hg, pulse is 112/min, and respirations are 18/min.  On physical examination, the patient appears to be in discomfort and is diaphoretic.  The abdomen is tender and rigid throughout.  Bowel sounds are absent.  Abdominal imaging shows free air under the diaphragm.  Intravenous fluids and empiric antibiotics are started, and surgical consultation is obtained.  While being prepared for laparotomy, the patient develops new-onset atrial fibrillation with a ventricular rate of 118/min.  The patient reports no palpitations, chest pain, or dyspnea.  Blood pressure is 110/70 mm Hg.  Which of the following is the best next step in management of this patient?

• A)Achieve a ventricular rate <90/min prior to surgery using digoxin therapy
• B)Achieve sinus rhythm prior to surgery using flecainide therapy
• C)Achieve sinus rhythm prior to surgery using transesophageal echocardiography-guided electrical cardioversion
• D)Administer a beta blocker for rate control and proceed with surgery without other intervention
• E)Obtain transthoracic echocardiography and proceed with surgery only if there are no abnormalities

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Definitions:

Hunger Signals

Physiological cues sent by the body to indicate the need for food intake, involving hormones, the central nervous system, and other bodily mechanisms.

Satiety Signals

Internal biological signals sent by the body to indicate fullness and control food intake.

Neurons

Specialized cells in the nervous system that transmit information to other nerve cells, muscle, or gland cells, through electrical and chemical signals.

Ghrelin

A hormone produced in the stomach that stimulates appetite, promoting the feeling of hunger.